Citation NR: 9742688
Decision Date: 12/30/97 Archive Date: 01/02/98
DOCKET NO. 93-27 717 ) DATE
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On appeal from the
Department of Veterans Affairs Regional Office in
Albuquerque, New Mexico
THE ISSUES
1. Entitlement to service connection for hypertension.
2. Entitlement to service connection for pituitary adenoma.
REPRESENTATION
Appellant represented by: The American Legion
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
R. K. ErkenBrack, Counsel
INTRODUCTION
The veteran served on active duty November 1955 to October
1959.
This case comes before the Board of Veterans’ Appeals (Board)
on appeal from the Department of Veterans Affairs (VA)
Regional Office (RO) in Albuquerque, New Mexico. In December
1995, the Board remanded the appeal to the RO for due process
consideration with respect to the issues listed on the cover
page of this decision. The appeal is once again before the
Board for appellate consideration.
CONTENTIONS OF APPELLANT ON APPEAL
The veteran contends, in substance, that hypertension and
pituitary adenoma either directly developed during active
service and/or resulted from his exposure to ionizing
radiation during active service.
DECISION OF THE BOARD
The Board of Veterans’ Appeals (Board), in accordance with
the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp.
1997), has reviewed and considered all of the evidence and
material of record in the veteran's claims file. Based on
its review of the relevant evidence in this matter, and for
the following reasons and bases, it is the decision of the
Board that the claim of entitlement to service connection for
hypertension is not well grounded and that the preponderance
of the evidence is against the claim for entitlement to
service connection for pituitary adenoma.
FINDINGS OF FACT
1. The claim of entitlement to service connection for
hypertension is without medical evidence of a nexus between
the current disability and any injury or disease during
active service, to include exposure to ionizing radiation.
2. All the evidence necessary for an equitable disposition
of the veteran’s claim of entitlement to service connection
for pituitary adenoma has been obtained by the Department of
Veterans Affairs (VA).
3. Pituitary adenoma was not present during or until many
years following active duty and did not result from any
injury or disease during active duty, to include exposure to
ionizing radiation.
CONCLUSIONS OF LAW
1. The claim of entitlement to service connection for
hypertension is not well grounded. 38 U.S.C.A. § 5107(a)
(West 1991).
2. Pituitary adenoma was not incurred in or aggravated by
active service, nor may it be presumed to have been incurred
in active service. 38 U.S.C.A. §§ 1101, 1131, 1137, 5107(a)
(West 1991); 38 C.F.R. §§ 3.307, 3.309, 3.311 (1996).
REASONS AND BASES FOR FINDING AND CONCLUSION
Hypertension
Factual Background
The service medical records show no complaint, finding or
diagnosis of hypertension. Blood pressure on the separation
examination was 118/72. The veteran is shown to have
participated in an atmospheric nuclear test series in the
Pacific Proving Grounds, Operation REDWING, from July 3 to
25, 1956, and sustained an accumulated total dose of exposure
to ionizing radiation of 100 rems.
Non-VA clinical records dated in April 1978 show blood
pressure of 114/80.
A VA examination in December 1979 showed blood pressure of
100/70.
Non-VA clinical records dated in March 1982 showed blood
pressure readings of 140/88 lying, 138/88 sitting, and 124/90
standing. In May 1983, the veteran was hospitalized with
chest pains and was found to have suffered a heart attack.
He reportedly had no prior cardiac history. He was described
as having hypertension, with readings of 160/110 on
admission, coming down to 110/60 with bradycardia and going
back up to 110/90. His hypertension became well controlled
in the hospital. A long history of hypertension was noted.
He had been treated with antihypertensive medication. It was
felt that hypertension was responsible for headaches.
Criteria
The threshold question that must be resolved with regard to a
claim is whether the veteran has presented evidence that the
claim is well grounded. See 38 U.S.C.A. § 5107(a) (West
1991); Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). A
well grounded claim is a plausible claim, meaning a claim
that appears to be meritorious. See Murphy, 1 Vet. App.
at 81. An allegation of a disorder that is service connected
is not sufficient; the veteran must submit evidence in
support of the claim that would "justify a belief by a fair
and impartial individual that the claim is plausible." See
38 U.S.C.A. § 5107(a); Tirpak v. Derwinski, 2 Vet. App. 609,
611 (1992). The quality and quantity of the evidence
required to meet this statutory burden of necessity will
depend upon the issue presented by the claim. Grottveit v.
Brown, 5 Vet. App. 91, 92-93 (1993).
In order for a claim to be well grounded, there must be
competent (medical) evidence that the veteran currently has
the claimed disability. See Rabideau v. Derwinski, 2 Vet.
App. 141, 143 (1992). There must also be either lay or
medical evidence of incurrence or aggravation of a disease or
injury in service. The veteran must also submit medical
evidence of a nexus between the in-service disease or injury
and the current disability. See Caluza v. Brown, 7 Vet. App.
498 (1995).
Where the issue is factual in nature, e.g., whether an
incident or injury occurred in service, competent lay
testimony, including the veteran’s solitary testimony, may
constitute sufficient evidence to establish a well grounded
claim; however, if the determinative issue is one of medical
etiology or a medical diagnosis, competent medical evidence
must be submitted to make the claim well-grounded. See
Grottveit v. Brown, 5 Vet. App. 91, 93 (1993).
A lay person is not competent to make a medical diagnosis or
to relate a medical disorder to a specific cause. See
Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992). If the
veteran fails to submit evidence in support of a plausible
claim, VA is under no duty to assist the veteran in the
development of the claim. See Grottveit at 93.
Essential hypertension may be service connected if it was
incurred in or aggravated by active service or if it became
manifested to a compensable degree within one year following
active service. 38 U.S.C.A. §§ 1101, 1131, 1137, 5107(a)
(West 1991); 38 C.F.R. §§ 3.307, 3.309 (1996).
To be eligible for service connection for hypertension, a
veteran must have current diastolic blood pressure readings
which are "predominantly" over 100, and must have had
diastolic blood pressure readings "predominantly" over 100
during service or within the one-year presumptive period
following service. Rabideau v. Derwinski, 2 Vet. App. 141,
143 (1992); 38 C.F.R. § 4.104, Diagnostic Code 7101 (1996).
Essential hypertension is not a disease specific to
radiation-exposed veterans. 38 U.S.C.A. § 1112(c); 38 C.F.R.
§ 3.309(d).
Essential hypertension is not a “radiogenic disease.”
38 C.F.R. § 3.311(b)(2).
Analysis
The Board finds that the veteran has not submitted a well
grounded claim for service connection for hypertension. His
bare assertion that current hypertension is either directly
related to active service or resulted from exposure to
ionizing radiation during active service is implausible,
since, as a lay person, he is not competent to make such
medical determinations. Such assertions are unsupported by
any of the relevant medical evidence on file.
In other words, the medical evidence, including the service
medical records, does not show any manifestation of
hypertension during or until many years following active
service. There is no medical evidence that hypertension did
or could have resulted from his exposure to ionizing
radiation during active service. Essential hypertension is
not a disease specific to radiation-exposed veterans nor is
it a radiogenic disease. Until the early 1980’s, more than
20 years following active service, no elevation in blood
pressure is shown to have developed. Without any inservice
manifestations, any manifestation until many years following
active service, or any medically supported connection with
active service, by reason of exposure to ionizing radiation,
or otherwise, the claim fails to be well grounded.
In light of the veteran's failure to meet the initial burden
of the adjudication process regarding his claim seeking
service connection for hypertension, the Board concludes that
he has not been prejudiced by the decision on such issue
herein.
The Board further finds that the Regional Office (RO) has
advised the appellant of the evidence necessary to establish
a well grounded claim, and the veteran has not indicated the
existence of any post service medical evidence that has not
already been obtained that would well ground his claim. Epps
v. Brown, 9 Vet. App. 341, 344 (1996), aff’d sub nom Epps v.
Gober, No. 97-7014 (Fed.Cir. Oct. 7, 1997).
Pituitary Adenoma
Factual Background
The service medical records show no complaint, finding or
diagnosis of pituitary adenoma, headaches or any abnormality
of the endocrine system. The veteran’s exposure to ionizing
radiation during active service is detailed above.
In April 1978, a non-VA physician saw the veteran for
complaints of headaches that he stated he had had for 19
years. Muscle contraction headaches related to tension were
indicated.
Non-VA X-ray examination of the sinuses in February 1982
revealed findings suggestive of pituitary disease. Pituitary
adenoma was diagnosed pursuant to
non-VA hospitalization in March and April 1982.
The veteran’s treating endocrinologist, N. F., reported in
November 1983 that the veteran had had a pituitary tumor that
was secreting prolactin since March 1982. He underwent a
partial resection in March 1982 and was left with
panhypopituitarism and associated problems. The physician
was aware of reports of an increased incidence of
hematopoietic tumors in men exposed to nuclear explosions.
He was unaware of any reports of an increased incidence of
pituitary tumors. The veteran did not have any of the
secondary effects that were well documented to be due to
exposure to ionizing radiation.
One of the veteran’s treating physicians, J. D. V., reported
in December 1983 that there was clear evidence associating
exposure to atomic bomb testing and subsequent development of
cancer. This was most common in the early stages after
exposure in terms of blood borne leukemias. Years after
exposure increases in the incidence of solid tumors,
particularly lung, stomach, breast and thyroid had been
documented. To the physician’s knowledge, there was no
documentation of an increased incidence of pituitary adenoma
from exposure to atomic bomb testing.
The veteran’s treating neurosurgeon, with respect to removal
of his pituitary tumor, M. B. G., reported in March 1992 that
the veteran had a good solid history indicating that he was
involved in high-level radiation exposure while in active
service in the 1950’s. The “literature” reportedly indicated
that there was “a strong possibility that this pituitary
tumor was related to the high exposure to radiation.” The
physician supported the veteran’s claim that the pituitary
tumor was a complication of the high-level radiation exposure
of the 1950’s.
In May 1992, the veteran’s treating endocrinologist, N. F.,
reported that the veteran had dated his problems back to when
he was exposed to radiation during active service in the
Pacific. Since then, it was expressed that he had suffered
from multiple medical problems, including a pituitary
adenoma, which had destroyed most of his pituitary gland
function. He related his medical problems to radiation. The
physician expressed that it was difficult to prove this
relationship but the health of the veteran had certainly been
much worse than would be expected with no other obvious
explanation.
The veteran had a personal hearing before a hearing officer
at the REGIONAL OFFICE (RO) in July 1993. He testified that,
about a week following his inservice exposure to ionizing
radiation at Operation REDWING, he began to experience
headaches. His headaches reportedly continued with no relief
from regular headache pain relievers until he had pituitary
gland surgery for an adenoma many years later. The pituitary
adenoma surgery and all related residuals he attributed to
his inservice exposure to ionizing radiation. Transcript
Page 1 (T1). He reportedly had had no headaches since his
pituitary adenoma was surgically treated. He felt that his
headaches had been caused by the growing adenoma pressing
against his brain. He recalled that he had been between 8
and 10 miles from ground zero when he was exposed to
radiation during active service. T2. He testified that he
stayed in the irradiated area for 3 1/2 weeks. He recalled
having worn a radiation dosimeter badge. T3.
Criteria
A pituitary adenoma may be service connected if it resulted
from an injury or disease incurred in or aggravated by active
service, to include exposure to ionizing radiation, or if it
became manifested to a compensable degree within one year
following separation from active service. 38 U.S.C.A.
§§ 1101, 1131, 1137, 5107(a) (West 1991 and Supp. 1997),
38 C.F.R. §§ 3.307, 3.309 (1996).
A pituitary adenoma is not a disease specific to radiation-
exposed veterans. 38 U.S.C.A. § 1112(c); 38 C.F.R.
§ 3.309(d).
A pituitary adenoma is not a “radiogenic disease.” 38 C.F.R.
§ 3.311(b)(2).
Service connection may be granted for a pituitary adenoma if
the claimant has cited or submitted competent scientific or
medical evidence that a pituitary adenoma is a radiogenic
disease. 38 C.F.R. § 3.311(b)(4) (1996).
The Court of Appeals for the Federal Circuit has held that a
claimant must be given the opportunity to prove that exposure
to ionizing radiation during service actually caused the
claimed disability, thereby warranting service connection
under 38 U.S.C.A. §§ 1110, 1131 and 38 C.F.R. § 3.303(d).
Combee v. Brown, 34 F.3d 1039, 1043-44 (1994).
Analysis
There is no dispute that pituitary adenoma was not manifested
during or until many years following active service. The
veteran has contended that headaches beginning during active
service following his exposure to ionizing radiation
represented the inception of pituitary adenoma, but there has
been no medical evidence to this effect, and no medical
evidence of headaches, in and of themselves, during or until
many years following active service. He himself is not
competent to provide credible evidence that inservice
headaches signified the inception of a pituitary adenoma.
See Espiritu v. Derwinski, 2 Vet. App. 492, 494 (1992).
In this case, the appellant was given notice of the
requirement for and an opportunity to supply competent
scientific or medical evidence that a pituitary adenoma is a
radiogenic disease. 38 U.S.C.A. § 5103 (West 1991);
38 C.F.R. § 3.311(b)(4) (1996).
The weight of the medical opinion evidence indicates that a
pituitary adenoma did not result from the veteran’s exposure
to ionizing radiation. Two physicians who have treated the
veteran extensively have reported that, while it is medically
established that exposure to ionizing radiation causes
cancer, there is no medical literature known to them that
shows or suggests an increased risk of developing a pituitary
adenoma as the result of exposure to ionizing radiation. His
endocrinologist reported in November 1983 that he knew about
the increased incidence of hematopoietic tumors in men
exposed to nuclear weapons, but was unaware of any such
increase for pituitary tumors and stated further that the
veteran did not have any of the well-documented secondary
effects of exposure to ionizing radiation.
Another treating physician of the veteran reported in
December 1983 that exposure to ionizing radiation produced
blood borne leukemias in the early stages following exposure
and, years after exposure, an increased incidence of solid
tumors of the lung, stomach, breast, and thyroid.
Nevertheless, to this physician’s knowledge, there was no
increased incidence of pituitary tumors following exposure to
ionizing radiation.
The one medical opinion favoring the claim was reported by
another treating physician of the veteran in March 1992. In
contrast to the others, but in far more general and
conclusory fashion, this physician stated that the
“literature” indicated a strong possibility that “this”
pituitary tumor was related to high exposure radiation. This
physician supported the veteran’s claim that the pituitary
tumor was a complication of inservice exposure to ionizing
radiation. This opinion contrasts to the more detailed and
completely opposite views of the two earlier medical
opinions. Even the later opinion by the veteran’s treating
endocrinologist, dated in May 1992, did not contradict his
earlier, more explicit, opinion that there was no scientific
or medical basis for concluding that a pituitary adenoma was
causally related to inservice exposure to ionizing radiation.
In fact, the cause of pituitary adenoma in this
endocrinologist’s view was unknown and unexplained.
Exercising the Board’s prerogative and mandate to resolve
factual issues, giving reasons and bases for its conclusions,
it is found that the preponderance of the medical evidence in
this case weighs against the proposition that a pituitary
adenoma is causally related in any way to the veteran’s
exposure to ionizing radiation. The more detailed and
specific medical opinions are found to outweigh, in probative
value, the more general and conclusory medical opinion given
in March 1992. See Sanden v. Derwinski, 2 Vet. App. 97, 101
(1992).
ORDER
A well-grounded claim not having been submitted, service
connection for hypertension is denied.
Service connection for a pituitary adenoma is denied.
DEBORAH W. SINGLETON
Member, Board of Veterans' Appeals
NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West
1991 & Supp. 1997), a decision of the Board of Veterans’
Appeals granting less than the complete benefit, or benefits,
sought on appeal is appealable to the United States Court of
Veterans Appeals within 120 days from the date of mailing of
notice of the decision, provided that a Notice of
Disagreement concerning an issue which was before the Board
was filed with the agency of original jurisdiction on or
after November 18, 1988. Veterans’ Judicial Review Act, Pub.
L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date
that appears on the face of this decision constitutes the
date of mailing and the copy of this decision that you have
received is your notice of the action taken on your appeal by
the Board of Veterans’ Appeals.
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